Healthcare Provider Details

I. General information

NPI: 1619832722
Provider Name (Legal Business Name): LAILA ABDULLA AL-HARTHY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1810 N 20TH AVE APT 1
MELROSE PARK IL
60160-1944
US

V. Phone/Fax

Practice location:
  • Phone: 312-947-0100
  • Fax:
Mailing address:
  • Phone: 872-305-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.548745
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: